The San Francisco Sheriff's Department is implementing a new city law allowing its staff to enroll inmates into health insurance under the Affordable Care Act. Sheriff Ross Mirkarimi believes that making sure people have health coverage when they're released will help prevent them from committing another crime and coming back.
One inmate – Sophia – recently requested help signing up for health insurance. Sophia, who asked that her last name not be used, was caught driving a stolen car in January and sentenced to three months in the county jail. She says that was because she stopped getting treatment for her substance abuse and mental health problems when her health insurance expired.
"It stopped in December and I didn't get it reinstated. So I didn't address any of my issues and I guess that's why I found myself in a car, driving around," she says.
Pretty soon, health insurance sign-ups like Sophia's will happen for all inmates at the San Francisco county jail — whether they request it or not. They'll happen right when most new arrivals get booked into custody.
"You have a captive audience," Sheriff Mirkarimi says. He wants to make sure the 30,000 prisoners who come through the jail system every year are covered on the day they're released.
The sheriff was behind the new city law that authorizes his staff to enroll people into health care plans under the Affordable Care Act, 24 hours a day, 7 days a week. Other counties and states are undertaking or exploring similar efforts for people exiting jail or prison.
Mirkarimi acknowledges that getting coverage is just one small step. Just because someone has a newly minted Medi-Cal card (California's version of Medicaid) doesn't mean they'll know how to use it.
"They're going to have to demonstrate the wherewithal and resourcefulness to use that Medi-Cal card," he says. "We, and our staff, help them get ready. But ultimately, it's on them."
People leaving jail or prison are going to need help on the outside if this plan is really going to work.
"And it's hard. So utterly hard," says Wanda Fain.
She was just released from state prison after 21 years. Everything is new to her. Getting on and off escalators is weird. Mobile phones are a new concept. She says she needs a friend just to help her ride the bus.
"They tell me what bus we’re on, they tell me what stops to get off," she said, "what specific things to look for so I won't miss a stop."
Navigating the health care system is even more confusing. Fain has multiple health problems: seizures, lymphoma, and bipolar disorder. In prison, the guards regulated all of her care for her. She wasn't allowed to eat a meal until she took her meds. But on the outside, it's up to parolees to find the right doctor, the right pharmacy - and to figure out which buses they need to take to get there.
"It's little things like that that people think are so easy," she said, shaking her head. "They are so overwhelming."
Fain says she's lucky that she lives near The Transitions Clinic in San Francisco. It's designed specifically for former prisoners, and staffed by former prisoners. They help patients find a job, a place to live, food, and see their doctor or psychiatrist all in one place. Juanita Alvarado is one of the community health workers.
"I was incarcerated," she says, "And I was homeless. And I had mental health [problems]. I was alone and scared and afraid. That's what I say to them and it usually opens a door."
Wanda Fain says the clinic staff are helping her get her life on track.
"They're very helpful because they’ve been there, done that. If I didn't have Juanita Alvarado, I don't know where I'd be," she says. "Probably on my way back."
Most people do go back: 61 percent of people who leave a California prison return within three years. But the federal government gave Transitions Clinic a special $6.8 million innovation grant created under the Affordable Care Act to expand the concept beyond San Francisco. The team is using the money to help 11 clinics in six states and Puerto Rico hire and train former prisoners to staff similar programs. Federal health officials believe this will ultimately save $8 million.
The even broader goal – for both Mirkarimi's plan and the Transitions Clinic – is that health care will help keep people from going back to jail or prison.